Post Traumatic Stress Disorder and the children of veterans

On Sunday, March 16, 2014, the lead item on CBS Sunday Morning was about how the trauma of war is often passed on to the children of veterans. The item concentrates on the current crisis with U.S. veterans of Iraq and Afghanistan and also touches on Vietnam through the story of Christal Presley who took years to understand the war had affected her father.The item is reported by Martha Teichner.

On her blog, Presley linked to an article I wrote for CBC News in March 2007 on the problems faced by children of traumatized veterans. Unfortunately, that story has now disappeared from the CBC website. So I am reposting it here.

Health

When war’s trauma spills over to the kids

Last Updated March 2007By Robin Rowland, CBC News
In late February 2007, media reports revealed that more than 40 children, all of soldiers who had served in Afghanistan, were suffering from some form of trauma.

To make things worse the children were waiting for treatment, caught in a bureaucratic squabble between the federal government and Ontario over who should pay. Most of the soldiers and their families are based at Camp Petawawa near Ottawa.

National Defence is responsible for the well-being of the soldiers themselves, but not for their families and maintains that the mental health of a family member is a provincial responsibility. Ontario Minister of Children and Youth, Mary Anne Chambers, told the Globe and Mail that the province had no money to clean up a problem that was a “direct consequence of federal government initiatives.”

The base commander at Petawawa, Lt. Col. David Rundle, says the bases family resource centre has provided $90,000 to a private group called the Phoenix Centre that provides services to the local community. It is supplying two clinicians to help with the problem. But according to Rundle, the money did not come from either level of government. In a letter to the Globe and Mail, he said, the money “came from funds donated by local businesses showing support for the troops and their families.”

Such largesse is commendable, of course, but probably misses the point. The possibility that children of adults suffering from post-traumatic stress disorder could have their own problems has been known and studied for more than 40 years and should have come as no surprise to either the federal or Ontario governments.

It was probably also no surprise then when Ontario Ombudsman André Marin, announced on March 2, 2007 an investigation into the matter, saying, “We’ve got 40 children who are suffering from psychological trauma and you’ve got, essentially, both levels of government washing their hands of it.”

Secondary traumatization

What is happening with these kids is what mental health professionals call “secondary traumatization” and “intergenerational transmission of trauma,” according research that can be found on the U.S. Department of Veterans Affairs website.

In Israel, in the late 1950s and early 1960s, psychiatrists and psychologists began to notice that some of the children of Holocaust survivors had many of the same symptoms as their parents.

One of the first major studies of intergenerational trauma took place at Montreal’s Jewish General Hospital where, beginning in 1972, Dr. Vivian Rakoff and her colleagues studied 144 families of Holocaust survivors. Her 1973 paper, “Some Second Generation Effects of the Survival of Nazi Persecution,” is considered a landmark and concluded that there was “homogeneity” between the behaviour of the children and their parents.

It also found that teenagers of Holocaust survivors had greater problems coping when compared to their peers in a clinical control group.
Not all children of Holocaust survivors demonstrated PTSD symptoms. But for those who did, the Israeli and other studies showed that the children’s behaviour varied from abnormal aggression to passivity. What most did demonstrate, however, were higher levels of anxiety than others in their age group.

A long history

Although initially confined to the professional literature, Helen Epstein’s 1979 book Children of the Holocaust became a best seller and brought the issue of multi-generational PTSD to broad public attention. Children and even grandchildren of Holocaust survivors continued to suffer because of the effect on their traumatized parents and because of the fact large numbers of their families, their support network, had been wiped out by the Nazis.

Subsequent studies have shown that children of traumatized war veterans around the world have faced similar problems.

For example, Betty Peters, a nursing research coordinator at an Australian repatriation centre, looked at the wives of veterans who had been imprisoned by the Japanese during the Second World War. She found that while some former prisoners saw their children as a lifeline and took great joy in their upbringing, others, usually the more traumatized ones, were impatient with their offspring and unable to communicate with them.

Many of the former POWs, Peters found, preferred to spend more time with their former comrades than their families since they felt that only their “mates” could truly understand what they went through.

A shopping cart of problems

How well the children of traumatized veterans cope seem to be dependent on a number of factors, including how well the veteran adjusts to civilian life and how the family as a whole deals with the situation.

Most of the recent studies have been done in the U.S., concentrating on the children of Vietnam veterans and, according to the U.S. Department of Veterans Affairs, the results have generally revealed that children with PTSD are at higher risk for behavioural, academic and interpersonal problems.

What’s more, their parents tend to view them as more depressed, anxious, aggressive, hyperactive and delinquent compared to children of non-combat, Vietnam-era veterans who do not have PTSD.

These studies also indicated that chaotic family experience can make it difficult to establish positive attachments to parents, which in turn can make it difficult for children to create healthy relationships outside the home.

Combat stress alone may not be the one factor behind these intergenerational problems. One U.S. study published in 1995 looked at both PTSD and the level of combat that had been experienced and concluded, “it was shown that child behaviour problems and marital adjustment were predicted primarily by PTSD rather than combat level.”

A 1999 study of Vietnam veterans from Australia came to similar conclusions about the transmission of PTSD within families. It reported that the partners of Vietnam veterans showed significantly higher levels of physical problems as well as anxiety, insomnia, social dysfunction and depression than the control group.

It also found that “the children of these veterans reported significantly higher levels of conflict with their families. However, the children showed no significant differences on measures of psychological distress and self-esteem from their counterparts.”

A follow-up study in Australia in 2001 compared 50 children of Vietnam veterans with 33 civilian peers and concluded: “Unhealthy family functioning is the area in which the effect of the veteran’s PTSD appears to manifest itself, particularly in the inability of the family both to experience appropriate emotional responses and to solve problems effectively within and outside the family unit.”

In 2004, the New England Journal of Medicine published a study of the PTSD among U.S. veterans from Afghanistan and Iraq. It found that measurable levels of PTSD were highest (17.1 per cent) among those who had served in Iraq, as compared with those who had served in Afghanistan (11.2 per cent), Vietnam (an estimated 15 per cent) or the general population, where stress disorders are in the three to four per cent range.

(It also noted that combat stress was higher in Iraq where approximately 11.6 per cent of U.S. soldiers were wounded or injured, compared to Afghanistan where only 4.6 per cent suffered that fate.)

The authors pointed out that in the past most studies of post-traumatic stress in combat veterans took place long after the conflict while current studies are more immediate and are filling in the gaps.

They also observed that many U.S. veterans are reluctant to report or go to counselling for PTSD because of a perceived stigma attached to the condition. This is a problem that has also been reported by the Canadian Forces. And if the veteran is reluctant to get help, that means the family also will likely not get the help it needs.